Healthcare Provider Details

I. General information

NPI: 1598651432
Provider Name (Legal Business Name): TAYLOR MICHELLE WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4334 LATHAM ST STE 110
RIVERSIDE CA
92501-1748
US

IV. Provider business mailing address

12100 MONTECITO RD UNIT 101
LOS ALAMITOS CA
90720-5819
US

V. Phone/Fax

Practice location:
  • Phone: 909-519-8912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: